In medicine, it is necessary for teams of people to play roles which in which information input and output, and often the exercise of psychomotor skills, must be coordinated in a highly organized manner. In addition to requiring types of information and making correct decisions, issues of precedence of action and both individual and group timing of actions become the keys to effective team performance. Obviously, the emergency room is a prime example of this highly skilled, highly timed teamwork, for the patient may die in several seconds of hesitance or extraneous action.
A general description of one of the medical activities simulated by the current invention offers a groundwork for the need for a new type of team simulator. Operating room teams anticipate cardiac arrest, and are prepared as part of their mission. However, Advanced Cardiac Life Support is an emergency activity--sometimes called a "code"--which takes place in every hospital in the emergency room, the critical and intensive care units, and in any other usable hospital area which is near to where a cardiac arrest occurs. The "code" is a result of a patient's heart stopping--called cardiac arrest--and when the heart stops, it will be approximately three or four minutes until the cells of the patient's brain begin to die from a lack of oxygenated blood to the brain. Thus the "code" activity must begin immediately upon anyone's knowledge of cardiac arrest. At times, especially outside the hospital, cardiopulmonary resuscitation (CPR) is used for temporary oxygenation and blood flow. But life stabilization requires a medical team working with greater tools and precision than in CPR. This Advanced Cardiac Life Support team should be formed within minutes, preferably within seconds, from any knowledgeable medical personnel in the area. There are usually no pre-set team leaders or members, except in the emergency rooms and intensive care units.
Although there will frequently be more personnel involved in an actual code, the minimum number of personnel required to administer Advanced Cardiac Life Support is usually four, (1) a team leader who is also responsible for administering defibrillation, (2) an oxygen administrator who is responsible for proper incubation and administration of adequate oxygen supply, (3) a person responsible for chest compression, and (4) one or more medical personnel responsible for intravenous (IV) administration of drugs and fluids and for taking blood samples for rapid assessment of blood gas levels in the patient. Obviously, with more than four people, some activities may be divided and others may allow switching over to back-up personnel as the "code" continues. "Stabilization" is achieved when the cardiac arrest patient is breathing without assistance, a regular and acceptable heart rhythm provides consistent blood flow to the brain and all parts of the body, and the body has an adequate supply of fluids and chemicals--even if supplied by intravenous tubes--to provide a normal chemical balance in the patient's heart and lung activity.
The Advanced Cardiac Life Support team is essentially providing several services to the patient in tandem: keeping the patient alive by expert and timely CPR intervention, accessing the patient's condition moment by moment, and providing various inputs--oxygen, chest compressions, electronic defibrillations, drugs, and fluids--all on a more precise and thorough basis than Cardio-Pulmonary Resuscitation (or CPR, which is also called Basic Life Support). Thus this simulator allows individuals to develop team skills without gathering a whole team in one location, and enables any practiced individual to instantly integrate with a team with little or no integration time. The simulator also enlarges the number of capable team members available when there is a cardiac arrest incident or "code." The number of such code-capable personnel available at the spontaneous incident then directly and measurably increases the chances of any patient surviving cardiac arrest with no brain-cell damage due to lack of oxygenated blood. The goal, of course, is stabilized breathing and heart rate.
Beyond this precise need for an emergency medical team, it is apparent that whenever teams must be able to coordinate in an urgent situation, it is necessary that they have practiced the procedure to fill each of their roles. Despite the high impact of quality team performance that is necessary to preserve life, in many cases the sheer logistics of pulling together people and equipment from remote locations now makes the time and cost for these team practices prohibitive. This also applies to surgeries, and to other types of training for team coordination.
Proposals of prior art have been made, specifically the patent of U.S. Pat. No. 4,360,345 granted Nov. 23, 1982 to David Hon. According to the proposals of that patent, there is provided a computer-controlled interactive instruction system for teaching an individual how to administer cardiopulmonary resuscitation. However laudatory those proposals may be, they were structure toward comparing a technique being adminstered to a dummy with standard indicia stored in the computer, and did not propose surrogate invasive travel within the subject. These proposals of this prior art were concerned with specific performances and external responses but did not contemplate a full range of indicia that would be necessary for life like simulation of a range of medical conditions including surgery. Accordingly, there continued to be a need for simulation that was life-like and that provided a full range of indicia that may be encountered when performing complex emergency surgical procedures on a living person. In addition, there continued to be a need for team simulation in which each team unit played a separate and differentiated role.
Another proposal of prior art is U.S. Pat. No. 4,907,973, granted Mar. 13, 1990 to David C. Hon. This proposal, entiltled: "Expert system simulator for modeling realistic internal environments and performance" represents an investigative medical system which must include a physical model representing physically and spatially the part of the body being operated upon, and one or more implements for input which give input to the simulation only, but with no output back to the user through the implement. However laudatory these prior proposals may be, the simulated experience called for in these instances of prior art are by their nature central and singular and focused in one location, and due to operation from first memory means only, the simulation changes in a like manner for all who may be inputting with various implements. The surgeries contemplated are only internal anatomical landscapes within a physical and spatial representation. Accordingly, there continued to be a need a team experience for team members in various remote locations with no physical or spatial representation of internal or external anatomy at any station, bringing in differentiated inputs from each of a plurality of remote stations, and giving out differentiated feedback to each of those stations by representations on visual, tactile, aural, and/or olfactory displays.